Pharmacotherapeutics For Advanced Practice Nurses Essay

Please give a response to the discussion post # 1 , #2 ,# 3 and # 4 with their reference separately . It is 4 response for 4 different person. at least 3 reference for each response.

# 1
Lorena Morris
Main Post
An 83-year-old patient living a skilled nursing facility presented to the emergency department. Upon admission, she was diagnosed with protein malnutrition with a medical history of malabsorption syndrome and difficulty eating due to not having her dentures. Pharmacotherapeutics For Advanced Practice Nurses Essay
Even though malnutrition can impact humans in so many ways such as delays in neurocognitive development, we have very little genetic understanding on the role genes play on malnutrition (Duggal and Petri, 2018).
Protein malnutrition occurs when the person does not have the adequate intake of nutrients needed, such as protein in this case. According to McCance and Huether (2019), malnutrition is an imbalance between nutrient requirement and nutrient intake. Furthermore, it can also involve the inappropriate absorption and the inappropriate utilization of nutrients. This patient is not taking in enough protein due to her eating difficulties. The patient also has a history of malabsorption syndrome which might prevent her from absorbing all the proper nutrients. Malabsorption syndrome can happen from any imperfection in the intestinal lining, such as in the small intestine, which is where most of the absorption of nutrients occurs. Additionally, this can lead to the impairment of nutrient absorption, impaired motility, and a compromised lymphatic function (Zuvarox & Belletiere, 2022). Protein malnutrition can increase the risk of fractures, delay wound healing, and increase the risk of infections.

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McCance and Huether explain that kwashiorkor, also called edematous malnutrition, is a protein deficiency. Physiologically, this malnutrition gives the patient inadequate nutrients such as proteins and the lack of these proteins results in intestinal inflammation hence the swollen abdomen in the patient. Furthermore, the liver swells and pancreatic atrophy occurs because there isn’t any protein to help in the release of lipoprotein. Proteins such as albumin help pull fluid into our vessels and help avoid keeping the fluid in one place, which can cause dependent edema, such as in the patient’s hands and feet. The patient in this scenario presented with generalized edema of her extremities and her abdomen, which are manifestations of kwashiorkor, as indicated in our textbook. Pharmacotherapeutics For Advanced Practice Nurses Essay
The cells involved in malnutrition are T-cells, which are important for our immune system and help us fight infection and cancer. With malnutrition, specifically protein malnutrition, the patient has a lack of proteins that are important in the development and function of T-cells (Collins, 2020). Since T-cells help fight infection and they are low in a patient with malnutrition, it can increase our chance of getting sick since our immune system may not be at working at its best.
This disease is very common among the elderly and perhaps under diagnosed. Other characteristics would be social determinants, specifically social class and economic standing. Patients who are less stable financially are more apt to eat less healthy foods. Junk foods have fewer useful nutrients, especially protein. Additionally, if the patient was a vegetarian and not sufficiently educated about finding non-meat alternative proteins, this could also be a factor. These characteristics could supplement the understanding of the cause of the malnutrition in the patient.
References
Collins, N. (2020). Dietary regulation of memory T cells. International Journal of Molecular Sciences, 21(12). Retrieved on February 27, 2023, from http://dx.doi.org/10.3390/ijms21124363Links to an external site.
Duggal, P., & Petri, W. A. (2018). Does malnutrition have a genetic component? Annual review of genomics and human genetics, pp. 247–262. https://doi.org/10.1146/annurev-genom-083117-021340Links to an external site. Pharmacotherapeutics For Advanced Practice Nurses Essay
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children. 8th ed., Elsevier Inc.
Zuvarox, T., & Belletieri, C. (2022). Malabsorption syndromes. In : StatPearls. StatPearlsPublishing. https://www.ncbi.nlm.nih.gov/books/NBK553106/Links to an external site.

#2

Ashley Newcomb

Protein Malnutrition
When looking at the scenario of the 83-year-old resident with protein malnutrition and a history of malabsorption syndrome one needs to look into many factors of why this individual not only a history of malabsorption but also is having trouble with malnutrition now. One factor that needs to be looked at is the role of genetics in malnutrition. Malnutrition is when an individual has impaired absorption causing an individual not to absorb nutrients in their body correctly.  Pharmacotherapeutics For Advanced Practice Nurses Essay There are many reasons an individual can become malnourished. One factor is the lack of proper nutrition to be absorbed into the body which can be caused by certain genetic diseases. One genetic disease that is known to cause impaired absorption is celiac disease. According to Duggal & Petri 2018, celiac disease is a T cell-mediated autoimmune disease were gluten affects the gut causing villous flattening and another autoimmune disease is inflammatory bowel disease which arises from commensal bacteria in genetically susceptible individuals. Another disease that is associated with malnutrition is cystic fibrosis. According to Schonenberger et al. 2019, cystic fibrosis is an inherited disease where there is a lack of pancreatic enzymes noted in the body which in turn causes malabsorption of fat, protein, starch, and vitamins like A, D, E, and K and can lead to protein malnutrition and fat-soluble vitamin deficiencies. Genetics can play a role in malnutrition however in this scenario there is not enough inPharmacotherapeutics For Advanced Practice Nurses Essayformation to suggest that this individual has a genetic factor affecting the malnutrition for her.
When looking at why this individual is presenting to the emergency room with generalized edema of the extremities and abdomen and protein malnutrition, we need to look into reasons why this is happening. There are many reasons an individual can get protein malnutrition. This individual lives in an extended nursing facility which can increase her risks and she is lacking dentures which can cause the individual not to be able to take in the proper amount of nutrients that she needs. While looking up information on protein malnutrition I found that Kwashiorkor is one type of malnutrition that causes fluid retention in the extremities and the abdomen. According to Benjamin and Lappin 2022, Kwashiorkor is a malnutrition disease where there is a severe protein deficiency and swelling in the extremities that usually effects children. However, Kwashiorkor can affect other individuals when they are in starvation too. The patient is most likely having a physiological response like this because of her lack of eating due to not having dentures. Also, as individuals age, they loss adipose tissue and muscle mass over the years causing them to become weaker and as individuals grow older, they develop more chronic diseases over the years. There are many factors like depression, poor dentation, dementia, etc. that can affect the way an elderly person responds to eating. Therefore, it is important to monitor individuals and find ways to help improve their nutritional status.
When looking at what cells are involved in an individual that has protein malnutrition and edema noted the epithelial cells are a major contributor in this case because of the edema. When an individual has problems with certain organs in their body edema can accumulate in many areas of the body. For example, kidney function and liver function affect the balance of fluids in the body because they filter out toxins and access particles that the body does not need anymore. When these organs do not work properly fluid is retained. In protein malnutrition many elderly individuals can get edema because they have kidney disease or liver disease. According to Nall 2018, albumin is a large amount of your blood within your body, when albumin low in the body edema can start occurring because of the lack protein within the blood stream. When this happens, the epithelial cells have trouble balancing water within the intracellular and extracellular space. Pharmacotherapeutics For Advanced Practice Nurses Essay
When looking at other factors that may contribute to this individual besides lack of dentation and a history of malnutrition there are several that need to be considered. For example, this individual lives in a nursing facility therefore are there anyone that can help her with plate during mealtime? Can the patient have a specialized meal set up for her like high protein shakes? Can her diet be modified to help her eat better? If this individual had someone to help feed her or a diet that was pureed this could help her to eat better. Is this individual confused? Sometimes taking the extra time to find out what the patient likes and dislikes can help them to eat better. Is she depressed? Is she on medications that affect her appetite? Can she be put on something to increase her appetite? Does the patient have family that can help? How long has this malnutrition history been going on? Has she just recently been diagnosed or was this from childhood? What other history does she have, chronic diseases? There are always other factors that need to be considered when taking care of any individual. For example, I took care of an individual that had a cognitive problem but by learning what he liked I was able to get him to eat 90 percent of his meal or better by offering him an extra chocolate milk after he ate so many bites. This helped this individual to eat more and not become malnourished and he got a treat for doing so good. By learning you patients you can make a big difference. Pharmacotherapeutics For Advanced Practice Nurses Essay

References
Benjamin, O. & Lappin, S. (2022). Kwashiorkor. National Library of Medicine National Center for Biotechnology Information. Retrieved March 1, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK507876/Links to an external site..
Duggal, P. & Petri, W. (2018). Does malnutrition have a genetic component? Annual Review of Genomics and Human Genetics. 19, 247-262. https://doi.org/10.1146/annurev-genom-083117-021340Links to an external site..
Nall, R. (2018). Edema in malnutrition. Healthfully. Retrieved March 1, 2023, from https://healthfully.com/edema-in-malnutrition-7850250.htmlLinks to an external site..
Schonenberger, K., Reber, E., Bally, L., Geiser, T., Lin, D., & Stanga, Z. (2019). Nutritional assessment in adults with cystic fibrosis. Nutrition. 67, https://doi.org/10.1016/j.nut.2019.05.010Links to an external site..
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#3

Deanna Ayres

Week 1 Discussion Post

When prescribing medications, the healthcare provider must consider many factors understanding pharmacokinetics and pharmacotherapeutics is essential in developing a personalized plan of care. Determining the right medication for a patient is not always easy and many factors must be considered. Pharmacokinetics is the study of what the body does in response to a drug through absorption, distribution, metabolism, and excretion (Rosenthal & Burchum, 2021). Pharmacodynamics studies the effects that drugs have on the body in depth looking at the biochemical, physiological, and molecular changes that take place in response to a medication (Rosenthal & Burchum, 2021). The purpose of this paper is to share a patient case scenario in which factors of pharmacokinetics and pharmacodynamics processes were considered in making a personalized plan of care. Pharmacotherapeutics For Advanced Practice Nurses Essay
In this patient scenario case study, I will be discussing a 72 year old white female patient who was admitted to the hospital with a DVT. She has a PMH that included: HTN, DVT, TIA, and PUD. She was started on a heparin drip per DVT protocol. Heparin has been proven to prevent extension of thrombus and to significantly reduce occurrence of both fatal and nonfatal and nonfatal PE and recurrent thrombosis. She would eventually be taken to Interventional Radiology to possibly have a thrombectomy or whatever treatment deemed necessary by the doctor. About 24 hours after the heparin drip was started, the patient’s labs revealed a significant drop in her platelet count sparking concern of heparin-induced thrombocytopenia (HIT). HIT is a serious complication that can occur while taking heparin. Looking at the pharmacodynamics, the immune system causes your platelets to clot in response to heparin, which results in a low platelet count. If this is not caught and treated in time, the results can be life-threatening. There is little known about what makes a person at risk for developing HIT, but it seems to be more common in females over the age of 40.
The plan of care for this patient would include closely trending platelet count, running the SRA (gold standard lab test to diagnose HIT), prescribing alternative anticoagulation treatment such as argatroban, fondaparinux, or an oral anticoagulation medication. Monitoring patient for signs and symptoms of new clot formation such as pain or tenderness, sudden swelling, discoloration, and skin that is warm to touch can often be signs of DVT formation. Obviously, if the SRA is positive for HIT it is also important to list heparin as an allergy on the patient’s chart as patients who have DVTs often have a reoccurrence. Knowing that the patient has a possible allergy to heparin will allow other forms of treatment for a DVT to be initiated without delay. When starting a medication such as heparin, a prescriber would also want to check a patient’s history for bleeding disorders such as disseminated intravascular coagulation (DIC), bleeding stomach ulcers, or history of brain bleeds. Pharmacotherapeutics For Advanced Practice Nurses Essay
In conclusion, prescribing the right medication regimen is not a one stop shop. A prescriber must have an understanding of the many factors that influence a patient’s drug therapy. Without this knowledge, some therapy plans may be detrimental and cause more harm than good to the patient (Laureate Education, 2012). A provider must take many factors into account when prescribing a medication. Equally as important is monitoring the response the body has to those prescribed medications and adjusting as necessary.

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Reference:
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Laureate Education, Inc. (Executive Producer). (2012). Introduction to advanced pharmacology. Baltimore, MD: Author.
Prevention and treatment of deep venous thrombosis and acute pulmonary embolism: American College of Chest Physicians Guidelines. (2016). Pulmonary Embolism, 639–645. Pharmacotherapeutics For Advanced Practice Nurses Essay https://doi.org/10.1002/9781119039112.ch123

#4

Collapse SubdiscussionLeyla Parsa
Leyla Parsa
YesterdayFeb 28 at 9:34am
Manage Discussion Entry
Case Study: The patient 40 year old female visited ED for chest pain that started 24 hours ago. The patient is Morbidly obese, with no history of cardiac issues. EKG negative, BMP negative, Troponin negative, Echocardiogram normal with EF 55-60%. History of High cholesterol, GERD, Diabetes type II. The patient currently takes Atorvastatin and the Patient was prescribed Zetia recently and started taking it for the last two days to lower the cholesterol for the lower target. Pharmacotherapeutics For Advanced Practice Nurses Essay
Atorvastatin belongs to the HMG-CoA group of drugs which decrease LDL by inhibiting hepatic HMG-CoA reductase, the limiting enzyme in cholesterol biosynthesis, in response to decreasing cholesterol production. Statins are available orally once a day that is prescribed based on individual target cholesterol.
Ezetimibe: acts on cells of the brush border of the small intestine to inhibit dietary cholesterol absorption, and also inhibits re-absorption of cholesterol secreted in the bile. Ezetimibe is an oral tablet and is available only in one dosage of 10 mg once a day with or without food (Rosenthal et al., 2021).
The Statin medications are predominately metabolized by the liver and Ezetimibe is metabolized by the gastrointestinal tract. Statin therapy is the primary treatment for lower low-density lipoprotein cholesterol (LDL). Statin drugs are associated with reducing LDL after one year 50% and decreasing the risk for cardiovascular issues, even though, statins have proven to be effectively lowering LDL Combination of Ezetimibe(Zetia) leads to lowering LDL by another 25% for patients whose LDL targets cannot be achieved( Sarraju et al., 2022) Pharmacotherapeutics For Advanced Practice Nurses Essay
A recent review of a randomized clinical study of 2440 patients confirmed that Ezetimibe did not cause adverse effects in terms of the increased level of hemoglobin A1c compared to the high dose of statin therapy, Ezetimibe add-on to low-dose statin for more than three months may even have effects lowering Hemoglobin A1c. The common side effect of Statin therapy is muscle pain, which is less with Ezetimibe (Vavlukis & Vavlukis, 2018).
Every patient requires to personalize treatment and therapy based on comorbidities, genetic predisposition, lifestyle, and plan of care. In some cases, multiple trials are needed to find the right medications for the patient to create the best outcome and reach the patient’s goal. In this case, a patient cannot tolerate Ezetimibe, and must be discontinued. Pharmacotherapeutics For Advanced Practice Nurses Essay

References
Rosenthal, L. D., Burchum, J. R., & Rosenthal, L. D. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants. Elsevier.
Sarraju, A., Ward, A., Li, J., Valencia, A., Palaniappan, L., Scheinker, D., & Rodriguez, F. (2022, January 7). Personalizing cholesterol treatment recommendations for primary cardiovascular disease prevention. Nature News. https://www.nature.com/articles/s41598-021-03796-6
Vavlukis, M., & Vavlukis, A. (2018, July 9). Adding Ezetimibe to statin therapy: Latest evidence and clinical implications. Drugs in context. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6044319/
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